Metronidazole for the Prophylaxis of Alveolar Osteitis: A Systematic Review and Meta-analysis

To assess, compare and evaluate the better effectiveness of metronidazole compared to conventional therapy for dry socket through a meta-analysis.

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used and registered in PROSPERO-CRD42023440597. Electronic databases were searched until April 2023 for studies evaluating the effectiveness of metronidazole compared to placebo and other conventional therapy and evaluating outcome in terms of reduction of incidence of dry socket, swelling and impact on healing. Quality assessment was evaluated using Cochrane risk of bias (ROB)-2 tool for randomized controlled trials (RCT) through its domains using RevMan software version 5.3. The risk ratio (RR) was used as summary statistic measure with random effect model (p < 0.05).

Twelve studies were included in review and eleven studies for meta-analysis. Quality assessment revealed a moderate to low ROB. It was observed that pooled estimate favoured metronidazole in reducing dry socket incidence-RR - 0.57 (95% CI - 0.24-1.33), reduction in swelling with RR - 0.62 (95% CI 0.12-3.25) and a greater impact on healing with RR - 0.25 (95% CI 0.12-0.52) were seen. Metronidazole was found to be superior compared to the placebo or conventional therapy. Funnel plot did reveal the presence of heterogeneity indicating the presence of publication bias.

Since, dry socket is the most common complication following third molar surgery, it is important for a clinician to take adequate precautions and consider regimes that can aid in reducing this incidence.